A 64-year-old diabetic and dyslipidemic woman was admitted to our hospital with a history of 3 episodes of acute pulmonary edema in the past 4 months, without evidence of organic heart disease. She was affected by a hypopituitarism and was treated with levothyroxine and desmopressin. She had atypical chest pain 1 year before, but 2 exercise stress tests were negative. In the past 4 months, she had been admitted 3 times for severe dyspnea at rest of sudden onset without chest pain, requiring endotracheal intubation because of severe acute pulmonary edema. Basal physical examination was normal. ECGs and serial troponin levels were normal. Clinical treatment was successful with early extubation. Echocardiography (echo) at rest was completely normal with normal left ventricular systolic and diastolic function and no valvular regurgitations. Coronary angiography revealed normal coronary arteries and normal global and regional left ventricular systolic motion. Thoracoabdominal computerized tomography was normal; and pulmonary thromboembolism, aortic disease, and suprarenal tumor were ruled out. Pulmonary biopsy also was normal. Laboratory tests including hemoglobin, electrolytes, autoantibodies, catecholamine, and thyroid hormones were also normal. Holter and telemetry did not reveal arrhythmias. Gated single-photon emission computed tomography and stress echo were negative for ischemia. Most of …